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Utilizing patient-specific 3D printed guides for graft reconstruction in thoracoabdominal aortic repair.

ABSTRACT: In thoracoabdominal aortic aneurysm repair, repairing the visceral and segmental arteries is challenging. Although there is a pre-hand-sewn and multi-branched graft based on the conventional image-based technique, it has shortcomings in precisely positioning and directing the visceral and segmental arteries. Here, we introduce two new reconstruction techniques using patient-specific 3D-printed graft reconstruction guides: (1) model-based technique that presents the projected aortic graft, visualizing the main aortic body and its major branches and (2) guide-based technique in which the branching vessels in the visualization model are replaced by marking points identifiable by tactile sense. We demonstrate the effectiveness by evaluating conventional and new techniques based on accuracy, marking time requirement, reproducibility, and results of survey to surgeons on the perceived efficiency and efficacy. The graft reconstruction guides cover the segmentation, design, fabrication, post-processing, and clinical application of open surgical repair of thoracoabdominal aneurysm, and proved to be efficient for accurately reconstructing customized grafts.

SUBMITTER: Kim T

PROVIDER: S-EPMC8429675 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Mri-based cancer lesion analysis with 3d printed patient specific prostate cutting guides.

Project description:Purpose: MRI methods have improved diagnosis and treatment planning for prostate cancer. However, validation and standardization is needed to encourage widespread adoption of these methods. The purpose of this study was to improve validation methods by creating a prostate cutting guide and to develop a method for 3D comparison between MRI data and post-prostatectomy histological tissue slices. Methods: Prostate Specific Membrane Antigen (PSMA) Positron Emission Tomography (PET)/MRI was performed on 10 patients with prostate cancer before and after chemohormonal treatment. Post-treatment images were used to design patient-specific prostate cutting guides that were used to create uniform thickness sections of surgically removed prostates. The thickness of the prostate tissue slices matched the imaging slice thickness so that comparisons could be made between MRI results and histopathological study results. A method was also developed to compare post-slicing prostate bulk geometry with the predicted MRI prostate geometry. Results: The prostate cutting guides were used to successfully section the prostate for histopathogical evaluation and slice-by-slice MRI comparison. Surface comparison results displayed an average dimensional difference of 1.99 ± 3.19 mm between MRI and post-prostatectomy slice reconstruction prostate geometries. Conclusion: MRI-based prostate cutting guides were designed, fabricated, and implemented in a study examining the utility and accuracy of MRI for the detection of prostate cancer. Furthermore, a three-dimensional part comparison method was developed, which can be used for validation of MRI with pathological and histological data. Future work will analyze more subjects to examine the effectiveness of these guides for histopathological prostate analysis with MRI and PET/MRI.

| S-EPMC6734042 | biostudies-literature

Bacteriological and mechanical impact of the Sterrad sterilization method on personalized 3D printed guides for mandibular reconstruction.

Project description:Surgical cutting guides are increasingly used for maxillofacial reconstruction. They are usually provided by laboratories. In recent years, surgical teams have published studies on the possibility of manufacturing their own cutting guides thanks to 3D printers. The object of this study is to analyze the impact of the sterilization on the surface of those personalized models and to assess the effectiveness of sterilization. Using the data from high-resolution CT scan of patient, 3D models were generated through computerized assisted design and fabricated with a 3D printer using Acrylonitrile Butadiene Styrene (ABS). For the sterilization, a Sterrad method was used. In order to evaluate the effectiveness of sterilization, 3D models were artificially contaminated with several bacterial reference strains, sterilized and finally cultured. The surfaces and mechanical modifications were analyzed before and after sterilization with infrared spectrometry, surface contact angle, extensometer, scanning electron microscopy and atomic force microscopy. Ten models of different shapes and 24 samples were fabricated, sterilized and analyzed. The 3D models were designed in 48 h, printed in an average of 122 min and underwent a 47 min cycle of sterilization. All experimentally contaminated 3D models were negative in culture, with at least, a six log reduction of the initial inoculum. The hydrophobicity and roughness of the surface suffered few changes. The reproducibility of this procedure was proved by identical results in the three sterilization rounds. Using Sterrad process for the sterilization of ABS printed material doesn't represent a bacterial risk for the patient. It is a feasible and safe innovative reconstructive method that can save time particularly for oncological cases.

| S-EPMC7804113 | biostudies-literature

Cochlear implant positioning and fixation using 3D-printed patient specific surgical guides; a cadaveric study.

Project description:HypothesisTo develop and validate the optimal design and evaluate accuracy of individualized 3D- printed surgical guides for cochlear implantation.BackgroundPositioning and fixation of the cochlear implant (CI) are commonly performed free hand. Applications of 3-dimensional (3D) technology now allow us to make patient specific, bone supported surgical guides, to aid CI surgeons with precise placement and drilling out the bony well which accommodates the receiver/stimulator device of the CI.MethodsCone beam CT (CBCT) scans were acquired from temporal bones in 9 cadaveric heads (18 ears), followed by virtual planning of the CI position. Surgical, bone-supported drilling guides were designed to conduct a minimally invasive procedure and were 3D-printed. Fixation screws were used to keep the guide in place in predetermined bone areas. Specimens were implanted with 3 different CI models. After implantation, CBCT scans of the implanted specimens were performed. Accuracy of CI placement was assessed by comparing the 3D models of the planned and implanted CI's by calculating the translational and rotational deviations.ResultsMedian translational deviations of placement in the X- and Y-axis were within the predetermined clinically relevant deviation range (< 3 mm per axis); median translational deviation in the Z-axis was 3.41 mm. Median rotational deviations of placement for X-, Y- and Z-rotation were 5.50°, 4.58° and 3.71°, respectively.ConclusionThis study resulted in the first 3D-printed, patient- and CI- model specific surgical guide for positioning during cochlear implantation. The next step for the development and evaluation of this surgical guide will be to evaluate the method in clinical practice.

| S-EPMC9312396 | biostudies-literature

Application of 3D-printed Customized Guides in Subtalar Joint Arthrodesis.

Project description:ObjectiveTo explore the feasibility of 3D printed customized guides assisting the precise drilling of Kirschner wires in subtalar joint arthrodesis.MethodsWe retrospectively reviewed the data of 29 patients (30 subtalar joints) who underwent subtalar joint arthrodesis between 1 July 2013 and 31 December 2017. The customized guides were designed on a full-scale 3D polylactic acid model made from computed tomography (CT) data of patients by Model Intestinal Microflora in Computer Simulation (MIMICS) software, which were manufactured by 3D printing technology. A total of 14 joints used customized guides (experimental group); the remained 16 joints used the traditional method (control group). The time of drilling the Kirschner wires to the correct position, the time of subtalar fusion, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and complications were evaluated in both groups.ResultsAll customized guides were successfully manufactured. In the experimental group, it took 2.1 ± 0.7 min to drill the Kirschner wire to the satisfactory position, and 2 cases needed to be re-drilled; in the control group, it took 4.6 ± 1.9 min to drill the Kirschner wire to the satisfactory position (P < 0.05), and 8 cases needed to be re-drilled. No serious complications occurred in both groups during and after the surgery. Postoperative radiographic fusion was confirmed in all cases. No significant difference was observed in the fusion time and AOFAS scores 1 year postoperatively between the two groups (P > 0.05).ConclusionIt is safe to apply 3D-printed customized guides for subtalar joint arthrodesis, which can assist the accurate drilling of Kirschner wires into the appropriate position according to the preoperative plan, and reduce the operation time as well as intraoperative radiation.

| S-EPMC6595118 | biostudies-literature

Alternative distal anastomosis during open thoracoabdominal aortic aneurysm repair for failed endovascular aneurysm repair.

Project description: Not available

| S-EPMC10267963 | biostudies-literature

Craniosynostosis surgery: workflow based on virtual surgical planning, intraoperative navigation and 3D printed patient-specific guides and templates.

Project description:Craniosynostosis must often be corrected using surgery, by which the affected bone tissue is remodeled. Nowadays, surgical reconstruction relies mostly on the subjective judgement of the surgeon to best restore normal skull shape, since remodeled bone is manually placed and fixed. Slight variations can compromise the cosmetic outcome. The objective of this study was to describe and evaluate a novel workflow for patient-specific correction of craniosynostosis based on intraoperative navigation and 3D printing. The workflow was followed in five patients with craniosynostosis. Virtual surgical planning was performed, and patient-specific cutting guides and templates were designed and manufactured. These guides and templates were used to control osteotomies and bone remodeling. An intraoperative navigation system based on optical tracking made it possible to follow preoperative virtual planning in the operating room through real-time positioning and 3D visualization. Navigation accuracy was estimated using intraoperative surface scanning as the gold-standard. An average error of 0.62?mm and 0.64?mm was obtained in the remodeled frontal region and supraorbital bar, respectively. Intraoperative navigation is an accurate and reproducible technique for correction of craniosynostosis that enables optimal translation of the preoperative plan to the operating room.

| S-EPMC6881390 | biostudies-literature

3D printed patient-specific aortic root models with internal sensors for minimally invasive applications.

Project description:Minimally invasive surgeries have numerous advantages, yet complications may arise from limited knowledge about the anatomical site targeted for the delivery of therapy. Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure for treating aortic stenosis. Here, we demonstrate multimaterial three-dimensional printing of patient-specific soft aortic root models with internally integrated electronic sensor arrays that can augment testing for TAVR preprocedural planning. We evaluated the efficacies of the models by comparing their geometric fidelities with postoperative data from patients, as well as their in vitro hemodynamic performances in cases with and without leaflet calcifications. Furthermore, we demonstrated that internal sensor arrays can facilitate the optimization of bioprosthetic valve selections and in vitro placements via mapping of the pressures applied on the critical regions of the aortic anatomies. These models may pave exciting avenues for mitigating the risks of postoperative complications and facilitating the development of next-generation medical devices.

| S-EPMC7455187 | biostudies-literature

Antegrade in situ fenestrated endovascular repair of a ruptured thoracoabdominal aortic aneurysm.

Project description:We describe a technique for antegrade in situ laser fenestration that has several advantages in the setting of ruptured thoracoabdominal aortic aneurysms. This technique involves rapid aneurysm sealing by deployment of aortic stent graft, followed by sequential incorporation of branch vessels using a laser probe through steerable sheath. The advantages of this technique include (1) rapid seal of the ruptured aneurysm, (2) preservation of the visceral and renal branch perfusion, (3) use of an off-the-shelf device, and (4) the ability to be performed without general anesthesia.

| S-EPMC7378364 | biostudies-literature

Successful use of angiotensin II for vasoplegia after thoracoabdominal aortic aneurysm repair.

Project description: Not available

| S-EPMC8303085 | biostudies-literature

Total abdominal debranching hybrid thoracoabdominal aortic aneurysm repair versus chimneys and snorkels.

Project description:Open thoracoabdominal aortic aneurysm (TAAA) repair remains a surgical challenge. Hybrid and total endovascular repair have emerged as alternatives in treating TAAA. Total endovascular TAAA repair may be best performed with branched/fenestrated stent grafts. However, these technologies are not yet widely available. Thus, currently total endovascular TAAA repair using the chimney/snorkel techniques is considered a viable option in many centers. In this article, we briefly review 2 readily available techniques with off-the-shelf devices, hybrid procedure using total abdominal debranching, and total endovascular repair using chimney/snorkel procedures. The hybrid TAAA repair avoids thoracotomy but requires laparotomy and carries high morbidity and mortality (eg, operative mortality, 4%-26% and renal failure, 4%-26%), comparable to traditional open repair. The staged hybrid approach has been proposed to minimize the invasiveness of the procedure, whereas the associated risk of interval aortic deaths is not negligible. Total endovascular repair reduces the morbidity and mortality after TAAA repair (eg, operative mortality, 3%-20% and renal failure, 0%-20%). However, it is technically demanding and the risks of future reinterventions-and need for repetitive surveillance-is inevitable (eg, immediate type I endoleak, 7%-16% and 1-year branch patency, 93%-98%). Currently, there are not enough data to determine which less-invasive option for open repair in patients with TAAA is superior. These alternatives should complement each other and be applied to carefully selected populations as a part of the overall toolbox in treating TAAA.

| S-EPMC8691180 | biostudies-literature

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